A great deal of the opposition to sex education is based on an absurd claim: if you teach children and teens about sex, it will encourage them to have sex. There’s absolutely no scientific evidence to support this claim, and it doesn’t make any sense. Teens decide to have sex with each other for many reasons, but the idea that they just heard about it for the first time and decided to try it out is ludicrous.

Similarly, the lactivism campaign to end free formula samples as US hospitals is also misguided and inane, not to mention completely disrespectful to grown women. The underlying assumption is that women who decide to formula feed do so because they just heard about it, have a free sample lying around, and decided to try it out. And just like abstinence only campaigns, so called “baby friendly” initiatives to promote breastfeeding have been complete failures.

Here’s a newsflash for lactivists: women formula feed because they want to do so and unless and until you address the real reasons, and stop pretending that this is a giant conspiracy on the part of “Big Forma,” all your campaigns are doomed to failure.

What is the Baby-Friendly Hospital Initiative USA? It is an attempt to foist guidelines created for the developing world onto women of the first world. It is led (surprise!) by a midwife and a lactation consultant.

The organizations’ precepts are based on the World Health Organization/UNICEF precepts for encouraging breastfeeding in developing countries. The use of formula in these countries is extremely problematic; indeed it can be deadly. When contaminated water is used to reconstitute powdered baby formula, serious illness is often the result. In the developing world, the WHO/UNICEF guidelines can make the difference between life and death.

Are guidelines drafted for countries where poverty is endemic, water supplies are contaminated, and starvation always a possibility, applicable to the US? No, they’re not, but, shhh, don’t tell any American women that. They must be convinced and shamed into breastfeeding by any means available. And that includes misrepresenting the risks and the state of the scientific evidence.

More than one million infants worldwide die every year because they are not breastfed or are given other foods too early. Millions more live in poor health, contract preventable diseases,and battle malnutrition. Although the magnitude of this death and disease is far greater in the developing world, thousands of infants in the United States suffer the ill effects suboptimal feeding practices. A decreased risk of diarrhea, respiratory and ear infections, and allergic skin disorders are among the many benefits of breastfeeding to infants in the industrialized world.

A million infants die each year? That’s right. Are any of them in the US? No (but don’t tell American women). The magnitude of death and disease is far greater in the developing world? That’s right. Are any term babies dying for lack of breastfeeding in the US? No (but don’t tell American women). Decreased risk of diarrhea, respiratory and ear infections and allergic skin disorders? Maybe (but don’t let American women know that these claims are in doubt).

What is the truth? The truth is that in a country like the US, breastfeeding has real benefits, but they are quite small. The quoted paragraph above is misleading and not strictly true, but for lactivists, the ends justify the means.

The biggest problem with the Baby-Friendly Hospital Initiative, though, is that it is a spectacular and expensive FAILURE. That’s not surprising, since there was never any scientific evidence that it would work in first world countries, just the heartfelt desire on the part of lactivists to shame and denigrate other women.

The volume of papers included – 77 primary studies and three reviews – might give the impression that there is ample evidence available to inform practice and policy. On the contrary, the most striking feature of this review is the paucity of findings from well-designed research to inform an important public health and policy issue. Even where studies had been conducted, details of interventions and processes were often scarce. Others have made similar observations …

Of course women might have told them that these efforts were bound to fail, but no one asked them:

It is notable that in a field in which the behaviour and views of women, their families and society are so crucial, few studies incorporated an assessment of participants’ views.

That’s not surprising. No one cares what women think. Lactivists only care what lactivists think.

Back to those who would restrict sex education with the express purpose of preventing sexual activity, Bioethicist Arthur Caplan made the following observations in regard “abstinence only” programs:

… there is no evidence at all that they work; common sense says they have no chance of working; and it is not clear that ethically they send the right message …

The same can be said about “baby-friendly” hospital initiatives:

there is no evidence at all that they work

common sense says they have no chance of working

it is not clear that ethically they send the right message

Number 1 is self-explanatory.

Number 2 is only to be expected. Any program designed to change behavior is doomed to failure if the designers don’t even bother to ask women their reasons for formula feeding, let alone respect and address those reasons.

As for number 3, it is ethically suspect to exaggerate the benefits of breastfeeding, pretend that that breastfeeding is a matter of life and death in the US, mislead women on the state of the scientific evidence and above all, to shame and scare women about formula feeding.

Lactivists like to pretend that women stop breastfeeding because of lack of education, because hospitals give out formula, because of lack of professional support, because of lack of peer support, etc. etc. etc. All this pretending reflects the profound unwillingness of breastfeeding advocates to avoid addressing the real reasons that women stop breastfeeding or fail to start in the first place. The truth about breastfeeding, a truth that lactivists refuse to acknowledge, is that starting is hard, painful, frustrating and inconvenient. And continuing breastfeeding is hard, sometimes painful, and incredibly inconvenient especially for women who work, which in 2012 is most women.

“Baby-friendly” hospital initiatives are misnamed. It would be more appropriate to call them “lactivist-friendly” since the only thing they reliably do is make lactivists feel good about themselves and their own choices. No program can be “baby-friendly” if there is no evidence that it works, if it does not address the real issues, and if it shames and denigrates the mothers of those babies.

Amy Tuteur, MD

Dr. Amy Tuteur is an obstetrician gynecologist. She received her undergraduate degree from Harvard College in 1979 and her medical degree from Boston University School of Medicine in 1984. Dr. Tuteur is a former clinical instructor at Harvard Medical School. She left the practice of medicine to raise her four children. Her book, Push Back: Guilt in the Age of Natural Parenting (HarperCollins) was published in 2016. She can be reached at DrAmy5 at aol dot com...
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